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NPI Code Detail

MEDICARE: DR. JOSEPH SEUNG WON LEE M.D.

MEDICARE: DR. JOSEPH SEUNG WON LEE M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
12084P0804XChild & Adolescent Psychiatry Physician50898MN

General Provider Information

NPI Number : 1790810984
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOSEPH SEUNG WON LEE M.D.
Provider Business Mailing Address
First Line : 11505 36TH AVE N
Second Line :
City : PLYMOUTH
State : MN
Zip : 55441-2304
Country : US
Telephone Number : 763-509-3818
Fax Number :
Provider Business Practice Location Address
First Line : 11505 36TH AVE N
Second Line :
City : PLYMOUTH
State : MN
Zip : 55441-2304
Country : US
Telephone Number : 763-509-3800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2007
Last Update Date : 05/29/2015

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